DIC

Most Common Etiologies

• Bacterial sepsis (83%), Trauma (31%), Cancer (e.g. APML, 6.8%), placental abruption, preeclampsia, amniotic fluid embolism, burn, hyperthermia, rhabdomyolysis, infection, transfusion reaction (ABO incompatibility), snake venom, aortic aneurysm

Pathogenesis

• Expression of the transmembrane glycoprotein TF (which activates factor VII and the extrinsic pathway)
• Consumption of clotting factors
• Widespread micro and macrovascular thrombosis, depletion of fibrinogen and fibrin clot formation
• Platelets are trapped in the clots
• Plasminogen --> Plasmin also upregulated, leading to large increase in clot breakdown and release of FDPs such as D-dimer.

Diagnostic Algorithm

Score of 5+ points strongly associated with DIC

• Presence of a disease known to be associated with DIC (2 pts)
• Platelets < 100k (1 pt), < 50k (2 pt)
• Fibrin degradation products (FDPs) (e.g. d-dimer): moderate increase (2 pt), strong increase (3 pt)
• PT > 3s (1 pt), > 6s (2 pt)
• Fibrinogen < 1 g/L (1 pt)

Treatments

• Basically don't get it.
• Treat underlying condition
• Treatment is lousy. Evidence behind treatment is likewise lousy.
• Platelets, cryo, FFP

Mortality

• 20-50%